Dengue Hemorrhagic Fever: A State-of-the-Art Review Focused in Pulmonary Involvement

Abstract

Dengue fever is an arboviral disease transmitted to humans through the bites of infected female Aedes mosquitoes. Dengue virus is a member of the Flaviviridae family, and human infection can be caused by any of the four antigenically distinct serotypes (DENV 1-4). The infection has become recognized as the most important and prevalent arboviral disease in humans, endemic in almost 100 countries worldwide. Nearly 3 billion people live in areas with transmission risk. Autochthonous transmission of the virus in previously disease-free areas, increased incidence in endemic areas, and epidemic resurgence in controlled regions could increase the risk of contracting more severe forms of the disease, such as dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). Symptomatic dengue virus infection can present with a wide range of clinical manifestations, from mild fever to life-threatening DSS. Thoracic complications may manifest as pleural effusion, pneumonitis, non-cardiogenic pulmonary edema, and hemorrhage/hemoptysis. No vaccine is currently available and no specific treatment for dengue fever exists, but prevention and prompt management of complications in patients with DHF can help reduce mortality. This review describes the main clinical, pathological, and imaging findings of thoracic involvement in DHF.

Keywords: Computed tomography; Dengue; Lung hemorrhage; Viral diseases.

Fig. 1

A 37-year-old woman with dengue hemorrhagic fever. Chest X-ray (a) shows bilateral perihilar and peripheral alveolar opacities. On HRCT (b), these changes correspond to areas of ground-glass opacities and consolidation

Fig. 2

A 40-year-old woman with dengue hemorrhagic fever. Chest X-ray (a) performed in the intensive care unit showing extensive bilateral airspace consolidations. HRCT images (b–d) show peribronchovascular and peripheral ground-glass opacities associated with consolidations in both lungs as well as bilateral pleural effusion. Note also in d the presence of small right pneumothorax

Fig. 3

A 22-year-old man with dengue hemorrhagic fever. High-resolution CT images at the level of the upper lobes (a) and just below the carina (b) show bilateral patchy ground-glass opacities. Note also a small pleural effusion in the right

Fig. 4

Histological section of the lung from autopsy specimen of a patient with dengue hemorrhagic fever shows diffuse filling of the air-spaces by blood (hematoxylin and eosin, ×40)